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y v Z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a <br /> APPLICATION FOR LAND USE PERMITS - <br /> OWNERRDYI TELEPHONE <br /> MAILING ADDRESS <br /> PROPERTY ADDRESS ' /0 ' <br /> LEGAL DESCRIPTION I ,. I ,JI, <br /> TYPE OF PERMIT(S): SINGLEE(-FAMILY DWELLING 0 ADDITION`0 DECK 0 GARAGE/ACCESSORY STRUCTURE 0 <br /> BUNKHOUSE 0 59.692(1V)GAZEBO 0 STAIRS$1 FILLING/GRADING 0 CAMPING UNIT ❑ <br /> \ ro <br /> COMMERCIAL BUILDING 0 COMMERCIAL ADDITION 0 COMMERCIAL ACCESSORY STRUCTURED <br /> i <br /> STRUCTURE/ADDITION USE: S I \ <br /> (Home/Cabin; Commercial siness; Bedroom; ck; etc.) r <br /> BUILDING CONTRACTOR: C] <br /> O 3 <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 1/1 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS C o <br /> WILL BE RETURNED. <br /> m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW M 'O 3 <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, 0 .. R <br /> AND INDICATE NORTH (N). Z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) p <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. U <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST) AND DRAINFIELD (DF), AND ALL DISTANCES 5. <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. i v. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN v .i <br /> NEEDED. /� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: vl <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. 1 ' c) Z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. N F <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. O <br /> 6. f <br /> 7. sp0 D5Oq 0 o nno ^0 <br /> nn m N R` tz1 <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my 9 0,° az B P R S <br /> knowledge and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all <br /> to = = a y <br /> Information contained in this application(Including any accompanying schedule)and I further declare that I recognize that this c.D D <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I <br /> further accept all liability that may be a result of the County of Burnett relying on this Inforrnatlon I am providing In this v v c b,N y=N [% <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have ° p <br /> access to the above-described premises at any reasonable time <br /> for the to of inspection. toc m R o�c Di 8 r) <br /> OWNER'S SIGNATURE <br /> f] � c <br /> (date) o,o E. <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE « = « « ^ <br /> � � 8oao8 <br />